La. Admin. Code tit. 40 § I-5155

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-5155 - Maintenance of Schedule

A. Maintenance of the schedules requires that a database of applicable charges be accumulated by the carrier/self-insured employer. This database will be utilized to profile the charges by each appropriate code.

B. Information Required. In order to update the schedule, each carrier/self-insured employer shall submit the following information for claims incurred in the preceding period. This information shall be submitted to the OWCA upon request. Failure to do so may subject the payor to penalties. The information required for calculation of the reimbursement schedule will include:

Field Name	Length	Type
CPT/HCPCS	5	Alpha/Numeric
Modifier	2	Alpha/Numeric
Unit/Days	3	Numeric
Amount Charged	10	Numeric
Amount Paid	10	Numeric

C. Communication Format. The above information shall be submitted in the following format.

1. Magnetic tape:

a. tape 9-tract, 8.5-inch to 10.5-inch reels with silver mylar reflector (standard reels) with write-ring removed;

b. recording density-1600 or 6250 bytes per inch;

c. recording code-Extended Binary Coded Decimal Interchange Code (EBCDIC);

d. header record must identify submitter and position of each field in the record;

e. tape must have a leading tape mark and an end of file mark;

f. the external label must identify the submitter, the date submitted, the tape number with identification of the total number of tapes submitted and a descriptive narrative of the information contained within the records.

D. Diskettes

1. A 5.25 inch diskette (floppy disk) that is IBM PC-DOS compatible with the following attributes:

a. double sided;

b. double density;

c. soft sectored;

d. 9 sectors per track; and

e. 40 tracks per diskette.

2. A 3.5 inch, 720K diskette, that is IBM PC-DOS compatible with the following attributes:

a. double sided;

b. double density.

3. The external label must identify the submitter, the date submitted, the diskette number with identification of the number of total number of diskettes submitted and the descriptive narrative of the information contained within the records.

La. Admin. Code tit. 40, § I-5155

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.